In her interview, Amandine talks about her approach to physiotherapymore focused on the origin of pain.
○ Can pain be our ally?
○ What are false beliefs and how can we deconstruct them ?
○ But also, how osteoarthritis can attack people under the age of 30.
5 aspects that define your vision of your job?
- First point: movement.
- Second point: the patient is at the center of rehabilitation. He's the one who's going to be the actor in the treatment.
- Third point: globality. We look at the patient as a whole, not just in terms of the knee that's going wrong, but in terms of his or her biopsychosocial context.
- Fourth point: give the patient freedom, so that he's free of his therapist and not dependent on him.
- Fifth point: make the link between body and mind, so that we can really look for the cause of the problem and not stop at the first aspect, which is the physical, but also look for the psychological causes, the emotional causes, stress, anxiety, many things can play a part in pain.
In your profession, you pay close attention to the influence of the mind on healing. Do you ever have patients whose pain is purely psychological and not mechanical?
The first thing I find interesting to remember is that: all pain comes from the brain. It's the brain that decides whether or not to send a painful impulse.
In fact, we can distinguish 2 different types of pain: pain resulting from trauma, where a tissue has been damaged, and pain resulting from a FEAR that the body has already experienced.
The brain remembers this and will reproduce the pain, despite the fact that nothing has been damaged at tissue level. This is the vicious circle of pain.
And so, yes, I can sometimes have patients who come to see me and who have no tissue problem, no problem directly linked to their body structure, to their muscles, but who in fact continue to have painful influxes coming from the brain because they have in fact had a bad memory of a certain movement.
The brain remembers this, and so we enter the chronic pain pattern.
Can you tell us an anecdote on this subject?
I had a patient in my practice who came to see me, and she explained that when she hears that her neck cracks, she automatically starts having a migraine within an hour or two, and these migraines make her suffer enormously.
I keep this in the back of my mind, thinking: oh my! Cracking, migraine, it's not normal for her to feel like that.
I ask her to come and try a little rotation, flexion and extension.
At that point, she looked at me in panic and said: "It's cracked, I'm going to have a migraine!" I told her straight out: "NO, that's FALSE!
So once I'd told her it wasn't true, I had to explain why it wasn't true.
I spent about 15 minutes really talking to her, because there was no way the two of them could be connected.
She had a false belief that: When I hear my neck crack, I automatically have a migraine.
I explained to her that the two had to be dissociated. I did what we call therapeutic education.
And after that session, she came back for the next one and I asked her: So how did it go after my session?
And she looked at me and said: I've never had another migraine since that session!
And she had them every day, at least when her neck cracked.
It just goes to show the extent to which the brain can believe certain things, and when we succeed in deconstructing these false beliefs, we break the vicious circle of pain.
What are the methods for deprogramming a brain responsible for chronic pain?
What I can tell you is that when we succeed in putting the patient in the situation that frightens him, in the very situation of false beliefs, we succeed in making him feel safe next to a therapist who knows his stuff.
By doing this movement: let's imagine that it hurts when I bend forward, we'll get the patient to do it in complete safety, so that the brain understands that there's no need to send a painful impulse. The tissues are fine, the back is fine, the movement doesn't hurt, and that's how we can reteach the brain that movements are good for the body and that there's no pain to send at that moment.
I think it's important to remember that pain is only sent by the brain to protect the body.
This enables us to avoid danger. For example, it allows us to avoid leaning on a foot that's completely broken, so pain can be seen negatively, but it can also be seen positively as an ally that allows us to listen to what our body has to tell us.
Can you give us an attitude to adopt on a daily basis to avoid joint problems?
There's only one word for it: Move!
There are no bad postures. There's no bad posture between the two, but what's worse is staying in the same position and not moving.
The aim is to get your body moving.
Is it true that osteoarthritis only affects the elderly?
Osteoarthritis doesn't just affect the elderly. Anyone over 25 can develop osteoarthritis of the back.
Let's be vigilant when we undergo X-rays, MRIs and other tests to find out what's wrong with our bodies. They often reveal pathologies that we don't particularly expect: a herniated disc, osteoarthritis of the spine, and in fact it's normal.
It's not a bad thing, but it's normal for it to suffer a little damage. Most herniated discs, for example, resolve themselves.
In one figure, it's almost 90%. So that's huge.
And osteoarthritis, likewise, can be symptomatic or non-symptomatic.
In other words, a person with osteoarthritis may have no pain at all, just as a person with back pain may have no osteoarthritis at all.
And so we therapists also have a duty not to make patients believe that their backs are fragile, that osteoarthritis is dangerous, that herniated discs are a godsend, that they shouldn't move any more, it's quite the opposite, we have to make them realize that it's normal, that our bodies are made to move and to continue moving for the rest of our lives.
For example, if a young man of 35 comes in for a back check-up and an x-ray reveals that he has osteoarthritis, is it really wise to say to him: "Sir, you have osteoarthritis", when that's not the reason he's come in?
Well, no, because that could create false beliefs in him, which isn't what we want and isn't what we're looking for either.